ACHRA Membership Application Please complete the fields in the form below and then submit. We will review your application and contact you shortly. Member Application Personal Applicant Information Name * Present Employer * Industry * Mailing Address * City * State * State * Virginia Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Business Phone * Email * Professional Background Information Job Title * Classification Of Position * Exempt Non-Exempt Time in Current Position * Current Areas of Responsibility / Description of Duties * If less than (3) years in current position, list previous work experience Employer's Name Employment Dates Position Held Duties If a recent College Graduate, please list recent College Education Dates of Enrollment School Degree / Course of Study Are you a SHRM Member? * Yes No SHRM Membership Number * Forms of Accreditation PHR SPHR CCP CBP SHRM-CP SHRM-SCP Other Professional Reference (Please list an individual who can attest to the above information) Reference's Name * Title * Employer's Name * Phone * I hereby apply for membership in the Alamance County Human Resources Association, and certify that the information provided is correct to my knowledge. Signature * Clear Date * Submit
